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INFLAMATORY BOWEL DISEASE

INFLAMATORY BOWEL DISEASE. Definition : IBD is a general term for a group of chronic inflamatory disorders of unknown etiology involving the GI tract -remains diagnosis of exclusion. 2 MAJOR GROUPS : ULCERATIVE COLITIS – colon involved CROHN’S DIDEASE – the hole GI tract EPIDEMIOLOGY

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INFLAMATORY BOWEL DISEASE

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  1. INFLAMATORY BOWEL DISEASE

  2. Definition: IBD is a general term for a group of chronic inflamatory disorders of unknown etiology involving the GI tract-remains diagnosis of exclusion • 2 MAJOR GROUPS : • ULCERATIVE COLITIS – colon involved • CROHN’S DIDEASE – the hole GI tract EPIDEMIOLOGY • most common in whites than in blacks and Orientals , with increased incidence in Jews compared to non-Jews • both sexes are equally afected • UC is most common than CD • 2,5% of persons with IBD will have ≥ 1 relatives affected • hereditary basis ± strong environmental component • GENETIC FACTOR : monozygotic twins, NO single marker • INFECTIONS : Pseudomonas, Yersinia enterocolitica (self limited , acute ileitis) • IMMUNOLOGIC: humoral antibodies to colon cells, bacterial antigens (E.coli, lipopolysacharides, foreign proteins), immune complexes –extraintestinal manifestations of IBD • PHYHOLOGICAL FACTORS: loss of a family member, anger, anxiety, depression are important in modifying the course of these disease and the response to therapy

  3. Etiology and Pathogenesis

  4. Etiology and Pathogenesis

  5. MORPHOLOGIC FEATURES • CD-often discontinuous : severely involved segments of bowel are separated from each other with segments of apparently normal bowel producing “skip areas”; in the ~ 50% of CD of the colon , the rectum may be separated. The transmural inflammatory process affects serosa , mezentery , fistula and abcess formation. • UC – the involvement is contigousand the rectum is almost always involved • CD - As a result of serosalinflamation, adiacent loops of small intestine may become adherent and matted together by a fibrinous peritoneal reaction leading to palpable mass , most often in the right lower quadrant • Microscopically, granulomas≠ UC (in rectal or colonoscopic biopsies). Chronic inflamation involving all layers of the intestinal wall  most caracteristic • 30% small intestine (terminal ileum) • 30% colonic involvement • 40% ileocolonic (ileum + right colon)

  6. CLINICAL FEATURES • Major symptoms: • bloody diarrhea • abdominal pain • fever (in severe forms) • weight loss (in severe forms) frequent liquid stools with blood and pus • severe cramps (signs of dehidratation , anemia) • Physical findings in UC are usually nonspecific (abdominal distension, tenderness along the course of the colon) • Mild cases – general examination is normal. • EXTRACOLONIC MANIFESTATIONS: • Arthritis ~25 % (knees, ankles, wrists ) ( FR,ANB,LE – for specific artritis) • Skin changes 15% • Liver disease

  7. LABORATORY FINDINGS • reflect the degree and severity of bleeding and inflamation : • iron deficiency anemia • leukocytosis, ↑VSH • hypokalemia • hypoalbuminemia- luminal protein loss from ulcerated mucosa • Peripheral arthritis in patients with colonic than small bowell involvement alone. Central artritis(ankylosingspondylitis )+ IBD is unrelated to the activity of the underlying bowel disease; HLA-B27 + ankylosingspondylitis whether or not IBD • Erythemanodosum, pyodermagangrenosum , aphthous ulcers (in active disease and than resolved), ocular manifestations (5%) ( episcleritis , recurrent iritis, uveitis ) • Liver function ALT, AST, AF ↑ = non specific focal hepatitis or fatty infiltration; non-progressive, remision • Pericholangitis– lesions of intrahepatic form of sclerosingcolangitis; non progressive and requires no therapy • Colangiocarcinomain the extrahepaticbiliary tree • Chronic active hepatitis  cirrhosis

  8. The clinical course of UC is variable. • Most of the patients will suffer a relapse within 1 year of the first attack recurrent nature of the disease • periods of remission with only minimal symptoms • in general, the severity of symptoms reflects the extend of colonic involvement and the intensity of the inflammation • limited colonic involvement (proctosigmoiditis  mild disease) with minimal systemic manifestation ( non extensive disease) • MAJOR SYMPTOMS: rectal bleeding + tenesmus • 85 % mild and moderate of intermittent nature that can be managed without hospitalisation • 15 % - fulminant course – entire colon- with systemic signs and symptoms • risc to develop toxic dilatation and perforation of the colon  medical emergency

  9. Clinical Overview

  10. Clinical Overview

  11. Crohn’s Disease Activity Index (CDAI) by Best

  12. Classification of Ulcerative Colitis

  13. Diagnostics: histological, radiological, sonographical

  14. Diagnostics/Follow-up in the Doctors Practice

  15. Diagnostics/Follow-up Gastroenterologist/Clinic

  16. Extraintestinal Manifestations and Complications

  17. Extraintestinal Manifestations and Complications

  18. Therapy Concepts

  19. Drug Therapy of Chron’s Disease

  20. Drug Therapy of Chron’s Disease

  21. Drug Therapy of Ulcerative Colitis

  22. Surgery CROHN’S DISEASE ULCERATIVE COLITIS

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